| 1. Abu Hamdeh et al. (2014)-Sweden |
To prospectively record the prevalence of SSI three months after standard intracranial neurosurgical procedures and analyse the incidence, impact and risk factors of SSI |
Prospective study |
Convenience sample of 448 patients-Neurosurgical ward at a tertiary hospital |
- Data were collected using the electronic patient journal system.- Analytical and descriptive statistics were explored |
9/10Transferability of research findings to other populations was not considered |
-Risk factors for SSI were meningioma, longer operation time, craniotomy as method of surgery, and staples in wound closure.-Patients with SSI had longer hospital stay- Longer and more complicated procedures heightened risk for SSI- The prevention of SSI was multidisciplinary |
| 2. Bekelis et al. (2016)-USA |
To investigate the association of operative duration in neurosurgical procedures with the incidence of SSI |
Retrospective cohort study |
94,744 patients who underwent a neurosurgical procedure- Database consisting of private hospitals |
-Retrospective cohort study involving patients who underwent neurosurgical procedures from 2005 to 2012-Statistical analyses was performed |
11/12Inadequate discussion regarding participant consent process |
-Longer operative duration was associated with increased incidence of SSI for neurosurgical procedures.-The results can be used to stratify patients regarding SSI risk. |
| 3. Bhatti & Leach (2013)-Wales |
To look at the infection rate in adults undergoing craniotomies without hair removal and compare the results with the usual practice of pre-operative shaving or clipping |
Prospective study |
100 adults who had elective supra-tentorial craniotomy for tumour removal-University hospital |
Patients were followed up prospectively to look for surgical site infection. The rate of infection was determined, and the results were compared with the published data on similar procedures where hair removal was carried out before surgery |
9/10Lack of details relating to the process of obtaining participant consent |
-Cranial surgery with hair left in place did not pre-dispose to an increased infection risk for adults undergoing tumour surgery.-There was no convincing evidence that pre-operative shaving led to a decrease in the incidence of post-operative wound infections- Removing hair before surgery dislodges resident micro-organisms on the skin from their normal location resulting in alteration of flora, colonization of micro-traumatised epidermal layers, enhancement of microbial growth and increases predisposition to infection post-surgery |
| 4. Cassir et al. (2015)-France |
To analyse the rates, types, and main risk factors for SSIs after neurosurgical procedures with a focus on the postoperative period |
Prospective cohort study |
849 adult patients undergoing neurosurgery-University hospital |
-A systematic review of the medical records of neurosurgical patients was undertaken from 2009 – 2010.-Key statistical analyses were performed |
11/12Recommendations were not supported by other robust evidence |
-The rate for SSI was 4.5% and active surveillance reduced this rate to 3.0%-The independent risk factors for SSI postcranial surgery included: previous surgery at the same site; intensive care unit (ICU) length of stay >7 days; duration of drainage >3 days; cerebrospinal fluid leakage-Active surveillance with regular feedback was effective in reducing SSI rates.-The postoperative period was associated with overlooked risk factors for neurosurgical SSI. |
| 5. Davies et al. (2016)-England |
To review the effectiveness of SSI surveillance guidelines and consider their appropriateness |
Qualitative study |
2375 patients undergoing cranial neurosurgery-Public hospital |
-Prospective follow up of all cranial neurosurgery procedures between October 2011 – February 2013-Descriptive data analysis was undertaken |
9/10Inadequate details pertaining to the relationship between researcher and participants |
-Active monitoring of inpatients and readmissions was considered vital for cranial neurosurgical SSI programmes. |
| 6. Fiani et al., (2020)-USA |
To conduct a retrospective analysis of neurosurgical patients following a contemporary wound closure |
Retrospective study |
1184 patients who underwent cranial and spinal surgery-Regional medical center |
-Retrieval of data pertaining to 1184 cases. Data were extracted from a centralised patient database and analysed using Ms Excel and retrieval software |
10/10 |
-Intrinsic risk factors for SSIs: CSF leak, prolonged duration of operation >4hrs, implantation of foreign material,-Factors lowering SSIs: use of antibiotic impregnated sutures, use of 5% chlorhexidine hair wash, lack of hair shaving-Extrinsic factors: male gender, tobacco smoking, diabetes, obesity BMI>35, UTI, hypertension |
| 7. Golebiowski et al. (2015)-Norway |
To explore the possible impact of duration of surgery on the risk of developing extracranial complications and surgical site infections following intracranial tumor surgery |
Retrospective study |
1000 records of patients who underwent intracranial tumour operations-University hospital |
-Retrospective review of patients who underwent planned surgery for intracranial tumors-Statistical analysis was performed |
9/10Researcher and participant relationship was inadequately addressed |
-Duration of surgery together with comorbidity and acquired neurological deficits were independent risk factors for cranial complications after brain tumour surgery.-Longer duration of surgery was associated with higher risk for developing SSWIs.-The risks associated with prolonging brain surgery should be considered preoperatively |
| 8. Haruki et al. (2017)-Japan |
To investigate the risk factors for Propionibacterium acnes infection after neurosurgery and to evaluate the prognosis for P. acnes-associated post-cranioplasty neurosurgical infection |
Retrospective case control study |
42 patients divided into 2 groups (14 cases and 28 control)-Community hospital |
-Medical records were retrospectively reviewed to assess the patients' baseline characteristics and risk factors from January 2004 to March 2016 |
10/11Outcome measures were from one single study site |
- Propionibacterium acnes was a prominent causative organism for post-neurosurgical infection- Craniotomy, malignancy, and prolonged operation time were identified as risk factors for the P. acnes infection |
| 9. Honeybul & Ho (2014)-Australia |
To assess the impact that injury severity has on complications in patients who have had decompressive craniectomy for severe traumatic brain injury (TBI). |
Prospective observational cohort study |
270 patients who underwent decompressive neurosurgery-Two major adult hospitals |
- The clinical and radiological data of patients on initial presentation were entered into a web-based prognostic model from 2004 to 2012. Data were prospectively examined to obtain the predicted risk of an unfavourable outcome which was used as a measure of injury severity |
12/12 |
-There was no associations between timing of cranioplasty after severe TBI and risk of infection or resorption of bone flap after cranioplasty. |
| 10. Jiménez-Martínez et al. (2021)-Spain |
To evaluate the care bundle intervention to prevent surgical site infections after craniotomy |
Historical control study |
-1017 Adult patients who underwent craniotomy between 2013 – 2017-Public hospital |
-Reviewing electronic clients’ charts, checking re-admissions, post discharge surveillance-Statistical analysis was performed |
9/10Relationship between researcher and participants was not clarified |
-The care bundle included: pre-operative shower with 4% chlorhexidine soap, hair removal, antibiotic prophylaxis, sterile wound dressing-The care bundle was effective in reducing SSIs post craniotomy |
| 11. Kose et al. (2016)-Turkey |
To investigate the effects of different types of shaving on body image and surgical site infection in elective cranial surgery |
Randomised-controlled design |
200 patients who underwent elective cranial surgery between March 2013–August 2014-Neurosurgery department at a military hospital |
-Patients were randomised to two groups: strip shaving and hair shaving using a randomisation block method and computer programme.-Statistical data analysis was performed |
11/11 |
-There is no difference between strip shaving and regional shaving in the development of surgical site infection after cranial surgery.-Regional hair shaving negatively affects the patients’ body image after cranial surgery. |
| 12. Luther et al. (2020)-USA |
To evaluate the rate of SSIs and perioperative complications associated with using an absorbable intradermal barbed suture for skin closure in hair-sparing supratentorial craniotomies for tumor in order to prove non-inferiority to traditional methods |
Retrospective study |
-446 records of patients post craniotomy for brain tumors were reviewed-University Hospital |
-Retrospective review of patient records who underwent supratentorial craniotomies for brain tumors between 2011 to 2017-Statistical analysis was performed |
10/10 |
-Hair sparing approaches to craniotomies are safe, equally effective and result in greater patient satisfaction, excellent cosmesis, quicker return to normal daily activities, and improved self-image prospectively.-Hair shaving techniques were recommended in combination with absorbable intradermal sutures to facilitate early discharge and return to normalcy for patients |
| 13. Patel et al. (2019)-England |
To determine the rate of SSIs requiring re-operation and identify factors leading to an increased risk |
Retrospective analysis |
16,513 patients at a single centre over a period of seven years |
-A single centre retrospective analysis-Multivariate binary logistic regression was used to analyse risk for developing SSIs |
10/10 |
Risk factors for SSIs included: Wound lead, dexamethasone use, instrumentation, operation duration > 3hrs, drain use, and diabetes |
| 14. Riordan et al. (2016)-USA |
To determine which patient characteristics and operative factors lead to post cranioplasty infections |
Retrospective chart review |
186 patients who underwent cranioplasty procedures-Level one trauma centre |
A single-center, retrospective chart review of patients who underwent cranioplasty procedures |
9/10No critical examination for researcher influence, role or choice of study location |
-Wound dehiscence and presence of a postoperative fluid collection was associated with a high rate of infection-The use of autologous bone flap and a state of immunosuppression trended toward statistical significance-There was no clear association between CSF Ventriculoperitoneal shunting in relation to cranioplasty infection |
| 15. Salle et al. (2021)-France |
To evaluate the impact of SSI on the survival of glioblastoma patients |
Retrospective multi-centred study |
- 64 patients from 14 neurosurgical centers |
-Data from SSI cases after glioblastoma surgeries between 2009–2016 were collected from multiple neurosurgical centers |
12/12 |
Recommendations to reduce rate of SSIs: Follow strict aseptic techniques in operating rooms, control risk factors such as monitoring for diabetes perioperatively, establish guidelines for management |
| 16. Shi et al. (2017)-China |
To determine the risk factors for and the incidence, outcomes, and causative pathogens of post-craniotomy intracranial infection (PCII) in patients with brain tumors |
Retrospective cohort study |
5723 patients with brain tumors who underwent elective craniotomy-Public hospital |
-Retrospective review of medical records of patients with brain tumors who had craniotomy- Statistical analysis was performed |
11/12Results were in relation to only one study center |
-Postoperative administration of antibiotics reduced the incidence of PCII-Risk factors included: prolonged operation (>7 h), external Cerebrospinal fluid (CSF) drainage, monitoring device placement, and postoperative CSF leakage.-Tumors located in the infratentorial or intraventricular regions were more vulnerable to PCII.-Gram-positive bacteria were the most common causative pathogens accounting for 82.0% of the PCII cases. |
| 17.Shibahashi et al. (2017)-Japan |
To review all post-operative complications and identify the risk factors for developing surgical site infection (SSI) after primary cranioplasty |
Retrospective study |
155 patients who underwent cranioplasty- Metropolitan Hospital |
-Retrospective chart review of patients who had undergone craniectomy due to intracranial hypertension at a single institution. |
10/10 |
- There was a significant relationship between operative time and SSI- A long operative time was a significant risk factor for SSI after cranioplasty- 8.4% of cases reviewed had SSI post cranioplasty |
| 18. Tanner et al. (2012)-England |
To explore the effect of SSIs on patients using qualitative methods to provide an in-depth understanding of the lived experience of suffering an SSI |
Qualitative study |
- 50 patients identified through a surveillance programme- Three public hospitals |
- Audio taped unstructured interviews were conducted and transcribed- Thematic content analysis was performed |
8/10Researcher - participant relationship was not clarified |
-The lived experiences of patients suffering with SSI were described as: living in horror; having physical effects e.g feeling weak, having pain; having psychological effect; feeling of relief for having survived surgery |
| 19. Wathen et al. (2016)-USA |
To identify the impact of workflow and personnel-related risk factors contributing to the incidence of SSIs in a large sample of neurological surgeries |
Prospective study |
12528 cases consisting of neurological patients-Neurological clinic |
-SSI data were obtained from prospective surveillance by infection preventionists using Centers for Disease Control and Prevention definitions.- Statistical analysis was performed |
10/10 |
- Patient body mass index and male sex were associated with an increased risk of SSI- Operating room personnel turnover was an independent variable that positively correlated with SSI. |
| 20.Yao & Liu (2019)-China |
To study the risk factors of intercranial infection after traumatic craniotomy in multiple trauma to provide references for clinical prevention and control of intracranial infection |
Logistic regression analysis |
94 multiple trauma patients with craniotomy (34 complicated with intracranial infection & 60 who had no infection post craniotomy-Public hospital |
Logistic regression analysis was undertaken. Statistical data analysis was performed. |
11/11 |
-Factors associated with SSI included:Surgical duration greater than 4hrs, postoperative CSF leak, external drainage, using the posterior fossa surgical approach |
| Oct 11, 2023
